Provider Demographics
NPI:1215243118
Name:LOWMAN, TRACY JO
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:JO
Last Name:LOWMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 S. EDWIN C. MOSES BLVD
Mailing Address - Street 2:G1
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417
Mailing Address - Country:US
Mailing Address - Phone:937-610-5555
Mailing Address - Fax:937-610-5554
Practice Address - Street 1:627 S. EDWIN C. MOSES BLVD
Practice Address - Street 2:G1
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417
Practice Address - Country:US
Practice Address - Phone:937-610-5555
Practice Address - Fax:937-610-5554
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN132072164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse